These forms are required if you plan on going through insurance on our Pedorthic side:

Prior to your appointment print and complete:

a) Patient Knowledge of Responsibility
b) Patient Facesheet
c) HIPAA Privacy Receipt Acknowledgement

To verify coverage with your insurance for custom orthotics please print, complete and bring to your appointment:

 Insurance Verification Form for Patients

Medicare Diabetic Shoe/Insert Coverage (print forms and follow steps below)
This form explains qualifying conditions and step-by-step instructions (diabetes only does not qualify, you must have a severe foot condition)

a) Patient Responsibilities

Print and take these 2 forms with you to your next appointment with the M.D. or D.O. treating your Diabetes

b) What Medicare Requires from the Certifying MD/DO

c) Statement of Certifying Physician for Therapeutic Footwear